Iv Test 2 Psych Meds

Front 1

what is depression?

Back 1

dec in serotonin and/or norepinephrine
- figured out in 1989

Front 2

1- What does SSRI mean?
2- Name key drugs

Back 2

1- Selective Serotonin Reuptake Inhibitor
2- Prozac (Fluoxetine) - made depression socially acceptable
- Luvox (Fluvoxamine)
- Paxil
- Zoloft
- Lexapro

Front 3

Serotonin Syndrome?

Back 3

- taking SSRIs after MAOIs (monoamine oxidase inhibitors); so avoid this combo;
- high temps, muscle rigidity, high CPK
- MAOI's: Nardil, Parnate

Front 4

1- SSRI side effects?
2- starts working when?

Back 4

1- little sedation, no wt gain,less sexual dysfunction, no cardio tox
2- starts working quicker in 1-3 wks

Front 5

What is GABA?

Back 5

- type of neurotransmitter; reduces aggression, excitation, anxiety
- stops Fight or Flight stress response, ie inhibits the stress/anxiety response

Front 6

5 types of Anxiety disorders?

Back 6

- Phobias
- PTSD Post Traumatic Stress Disorder
- GAD General Anxiety Disorder
- OCD Obsessive Compulsive Disorder
- PD Panic Disorder

Front 7

1- 2 main groups of antianxiety drugs?
2- 3rd group of drugs used to relieve physical symptoms of anxiety such as stage fright, and also are cardiac drugs?

Back 7

1- Benzodiazepines (Xanax, Valium, Ativan) & Buspirone (Buspar)
2- Beta Blockers ( propranolol (Inderal), Atenolol (Tenormin)

Front 8

which antianxiety drug reduces anxiety but doesn't "make your life better" (like benzos)?

Back 8

Buspirone (Buspar)
- reco'd for phobias, GAD
- cheap & very good
- no tolerance or dependency; takes long time to work - 3 wks, therefore not a good stat or PRN drug, but good "outpt drug"; the longer a drug takes to work, the lower the addiction since its harder for the brain to make the connection

Front 9

which is more sedating- benzos or buspirone?

Back 9

benzos

Front 10

How do benzodiazepines work?

Back 10

- CNS depressant
-simulate GABA to inhibit stress/anxiety response
- benzos also used to relax smooth muscle, treat convulsions
- only approved for s/t use since dependence & tolerance develop
- excellent stat & prn meds since fast onset 10-14 days
- good "in-pt" med
- not for primary treatment of OCD and PTSD

Front 11

1- Which drugs are not reco'd for pts with addiction issues?
2- which drug has high suicide potential when mixed w alcohol?

Back 11

1- Benzos
2- Benzos

Front 12

4 types of antidepressants?

Back 12

1- MAOI's - monoamine oxidase inhibitors - Oldest class Dev 1950s; Ex: Nardil & Parnate
2- TCA's - tricyclic antidepressants- Dev 1970s increase norepinephrine; Ex: Elavil
3- SSRIs- selective serotonin reuptake inhibitors- Intro'd 1989; effect serotonin levels; Ex: Prozac, Zoloft, Lexapro
4- NSSRIs - (Norepinephrine & Serotonin Specific Reuptake Inhibitors) for pts where SSRIs didn't work; inhibits reuptake of both serotonin & norepinephrine.

Front 13

1- Biggest side effect of MAOI's?
2- Biggest toxic effect?

Back 13

1- Hypotension, esp w older adults
2- Hypertensive crisis: headache, stiff neck, flushing, cold clammy skin, tachycardia, severe nosebleeds, N&V, chest pains, stroke

Front 14

what causes hypertensive crisis?

Back 14

MAOI's inhibit metabolism of tyramine which causes massive vasoconstriction and excessive stimulation of heart; foods high in tyramine can cause hypertensive crisis
- Ex of bad foods (high tyramine content): Aged, preserved, smoked foods, cheese, beer, Chianti wine, avocados, bananas
Ex of good foods (low tyramine )- most veg, most fruits, fresh meat & fish, milk, yogurt, cottage cheese, most wines and beers

Front 15

TCA's cause anticholinergic side effects. These are:

Back 15

include dry mouth, blurred vision, constipation, urinary retention, tachycardia

Front 16

2 watchouts for antidepressants?

Back 16

1- Don't abruptly discontinue antidepressants since it could have strong depression rebound ie, increase in suicidal ideation and actions
2- Therefore, esp kids need monitoring if on antidepressants. SSRIs have a black box for adolescents; teens do better with talk therapy rather than meds

Front 17

In ER, major dep & bipolar dep look the same; need pt hx to differentiate; if you give antidepressants to bipolar dep pt, could throw them into rapid recycling. So, without good Hx, ER may not give any meds until they're sure what pt has.

Back 17

T

Front 18

What SSRI is specific to treating OCD symptoms?

Back 18

Luvox

Front 19

Lithium is drug of choice for ____

Back 19

Bipolar (aka manic/depressive)
- Lithium is not popular w manics since 1) manics like to be manic & lithium dec hyper activity by enhancing the reuptake of norepinephrine and serotonin (thereby lowering levels)

Front 20

What causes increase in lithium levels?

Back 20

- decrease sodium intake
- fluid loss from severe sweating, dehydration, diarrhea

Front 21

1- Therapeutic levels of lithium are____ mEq/L?
2- Lithium toxicity occurs with levels over ____

Back 21

1- 0.8- 1.4 mEq/L
2- 1.5mEq/L

Front 22

What is rule for lithium trmt for older adults?

Back 22

geriatrics - start slow go slow

Front 23

1 - early signs of lithium tox?
1A- nursing interventions?
2- severe signs?
2A- nursing interventions?

Back 23

1- N&V, diarrhea, thirst, polyuria, slurred speech, muscle weakness
1A- withhold lithium, measure blood levels.
2- coarse hand tremor, GI upset, confusion, ECG changes, blurred vision, polyuria, seizures, severe hypotension, coma, cardiac dysrhythmias, peripheral circ collapse, proteinuria, oliguria, death
2A- no known antidote; drug is stopped and excretion is hastened via emetic, gastric lavage; hemodialysis is used in severe cases.

Front 24

If pt comes in manic, take lithium up to 0.8-1.4mEq/L to control hyperactivity; once controlled, you titrate to maintenance level (0.4-1.0 mEq/L) to limit side effects.
- maintenance level is defined as how low lithium can go before your symptoms come back.

Back 24

T

Front 25

Bipolar behavior can be manic which is caused by increased levels of ____ . Or it can be depressed, caused by decreased levels of ____

Back 25

dopamine, serotonin

Front 26

For bipolar, it's become popular to give 2 smaller dose meds vs 1 med to cover more symptoms and reduce side effects, esp w kids.

Back 26

Ex: Docs now treat bipolar with combo antipschotics and anticonvulsants (Lithium) with the antipsychotics allowing pt to take lower dose of anticonvulsant

Front 27

How do anticonvulsants work?

Back 27

stabilize electrical conduction within neurons to stabilize the neurotransmitters. This is different than treating depression, which affects neurotransmitters in synaptic space.
So rather than a seizure causing tonic-clonic movements, the seizure affects feelings and behaviors. So bipolar is a physiological disorder.

Front 28

Bipolar can be called a ___ disorder. It affects 1-3% of population.

Back 28

seizure

Front 29

1st Generation antipsychotics aka ____ and aka ______ . These drugs decrease dopamine in basal cell ganglia, and produce very strong motor side effects

Back 29

Phenothiazines; typical antipsychotics

Front 30

Name 2 TYPICAL antipsychotics?

Back 30

Haldol, Thorazine
- decrease dopamine in basal cell ganglia
- these treat only POSITIVE symptoms of schizophrenia.
- strong motor side effects ie, EPS (Extra Pyramidal Symptoms)

Front 31

Name 2 ATYPICAL antipsychotics?

Back 31

Clozaril, Risperdal, Seroquel
- decrease dopamine in limbic system (emotional part of brain)
- little to no motor side effects
- treats positive and negative symptoms

Front 32

Name 4 EPS symptoms of TYPICAL ANTIPSYCHOTICS?

Back 32

1- pseudoparkinsonism
2- acute dystonic reaction
3- akathisia
4- Tardive dyskinesia

Front 33

pseudoparkinsonism? Symptoms and treatment?

Back 33

Symptoms: masklike face, pill-rolling
- can occur can occur a short time after taking meds, ie, could be hrs or days; skinny women have higher risk than heavy men
Treat: alert medical staff; treat with oral anticholinergic agents, ie Cogentin or Artane; if difficulty swallowing, inject Benadryl

Front 34

1st Generation antipsychotics aka ____ and aka ______ . These drugs decrease dopamine in basal cell ganglia, and produce very strong motor side effects

Back 34

Phenothiazines; typical antipsychotics

Front 35

Name 2 TYPICAL antipsychotics?

Back 35

Haldol, Thorazine
- decrease dopamine in basal cell ganglia
- these treat only POSITIVE symptoms of schizophrenia.
- strong motor side effects ie, EPS (Extra Pyramidal Symptoms)

Front 36

Name 2 ATYPICAL antipsychotics?

Back 36

Clozaril, Risperdal, Seroquel
- decrease dopamine in limbic system (emotional part of brain)
- little to no motor side effects
- treats positive and negative symptoms of schizophrenia

Front 37

Name 4 EPS symptoms of TYPICAL ANTIPSYCHOTICS?

Back 37

1- pseudoparkinsonism
2- acute dystonic reaction
3- akathisia
4- Tardive dyskinesia

Front 38

pseudoparkinsonism? Symptoms and treatment?

Back 38

Symptoms: masklike face, pill-rolling
- can occur can occur a short time after taking meds, ie, could be hrs or days; skinny women have higher risk than heavy men
Treat: alert medical staff; treat with oral anticholinergic agents, ie Cogentin or Artane; if difficulty swallowing, inject Benadryl

Front 39

dystonia ?

Back 39

impairment of muscle tone; contractions

Front 40

Opisthotonos?
Oculogyric crisis?

Back 40

-titanic heightening of entire body
- eyes locked upward
both are part of EPS symptoms

Front 41

Akathisia?

Back 41

restlessness and agitation, can't sit still

Front 42

Tardive dyskinesia?

Back 42

involuntary spasms of tongue, lips, fingers/toes, jaw, neck, trunk
Movements: CHOREIC: rapid purposeless, irregular movements; ATHETOID: slow, complex serpentine movements
-THORAZINE SHUFFLE
- serious motor disturbance that occurs after high doses of TYPICAL (aka Phenothiazines) and long term use (over 2 yrs) ; pts should be screened every 3 months
- NO KNOWN TREATMENT- stopping drug may or may not decrease symptoms

Front 43

How do you recognize NMS aka Neuroleptic Malignant Syndrome?

Back 43

high fever
- somewhat rare, potentially fatal,
- severe EPS symptoms - severe muscle rigidity
- caused by TYPICAL ANTIPSYCHOTICS

Front 44

which atypical antipsychotic drug causes agranulocytosis?
Clozaril (clozapine)
Risperdal
Zyprexa

Back 44

Clozaril: intro'd in '93 & pts needed wkly blood work so not to dev agranulocytosis, so other drugs were found
the other 2 are atypical antipsychotics but don't cause SE of agranulocytosis